Wednesday, April 10, 2013

Being Schooled

An interesting phenomenon is occurring in media circles these days. No doubt others have seen it, too.

Lately, doctors are being schooled by the media.

From how to learn empathy, to improving communication with patients, the breadth and depth of what we should do for our patients is endless. Why, some even have our own colleague "experts" tell us how we should reallydo things.

These efforts, while probably well-intentioned, are patronizing. Do doctors tell journalists how to write or what to print?

Why are doctors seeing these main stream media efforts? Is it because most doctors are really incapable of the ability to listen and communicate with our patients? Is it because we must keep a stiff upper lip for what's coming in 2014? Or is this not-so-subliminal agenda of social engineering underway for some other reason?

It goes without saying that all of us should communicate better. (Think how many wars or family fights we could have avoided if we had, for instance.) And every doctor should turn their head away from computer screens and toward their patients, hold the patient's hands, look into their eyes, listen to their concerns, put ourselves in their place, do a thorough physical exam, have constant empathy and insight, read back medications, write out written instructions in 5th grade English, escort our patients back to the waiting room, or utilize highly skilled and educated assistants with all of these tasks, too. But the reality is this: time and ancillary resources are limited these days for doctors. Helpers cost money. Productivity must occur before new helpers are hired. More people than ever are entering health care thanks to intense marketing campaigns and new mandates for care. And there are so many doctors with only so many minutes in the day.

So doctors have to triage. Sickest first. We move as fast as we can to remain productive, because that's what's REALLY valued in healthcare these days. So is patient loyalty because that's what keeps them coming back. But in the process of growing loyalty, we increasingly have to document everything or other payers think it doesn't happen. So we type. And click. And type. And click. And print. To get paid. Talk about a communication and empathy buzz-kill!

Yet for those looking in, we must communicate better! "Listen to our "experts!" they proclaim.

Medicine was once considered a place where patients could confide in their doctors about their most intimate concerns and doctors had time to listen. Notes were one- or two-line jots in a chart. We'd spend the extra time because we were valued for our skills and for our knowledge and there was more to it than just pay. We had skin in the game. We got paid in chickens. We knew our patients. Back then, seven-minute appointments didn't exist. Now, doctors are cultivated as shift workers. Patients have Google. Everyone has information at their fingertips. Our new story line has become there are no limits to what patients can have in health care. Perfect data. Perfect health care access. Error-free health care with perfect delivery. Perfect communicating doctors. Always. We're building our medical Utopia.

But this effort to school doctors on our path to Nirvana has a serious downside for health care workers on the front lines.

As I've said before, there's a growing culture of hostile dependency that continues to grow toward doctors these days.
The theme is like an adolescent who realizes his parents have feet of
clay. He comes out of his childhood bubble and realizes his parents
have failures and limitations because they are human beings. This
results in the adolescent feeling unsafe, unprotected and vulnerable.
Since this is not a pleasant feeling, narcissistic rage is triggered
toward the people he needs and depends on the most. None of this occurs
at a conscious level. Most of us understand this behavior simply as
"adolescent rebellion," not understanding the powerful issues at
play. So when we spotlight one side of what doctors should do for patients, be it improve communication or empathy (or whatever) without
acknowledging the realities health care workers face like looming
staffing shortages and pay cuts, we risk fanning the flames of
narcissistic rage against the very caregivers whom we depend on the most
- the very caregivers who are striving to communicate, do more with less, check
boxes while still looking in the patient's eyes, meet productivity
ratios, all while working in a highly litigious environment.

So be careful. Maybe we should school doctors less and value them more.

Who knows? Such a move might make things better for everyone in the long run.

5 comments:

Anonymous
said...

the media is instructing everyone and doing so with impunity. They are also selecting what and how they will present their viewpoint. Facts are irrelevant.. suppression is a way of business.. witness Philly abortionist trial.. Who outside of Philly has heard of it? Because of our abysmal education system and a society which really does not value logic, wisdom, and prudence, we have citizens who are led by the headlines combined with adolescent immaturity.. which is not to say it would be nice to see the doctor's eyes every once in a while. In short your column today is an object lesson in the nanny state gone wild..with their enforcers..the media. Glad I am " healthy" and old! peace, Dr. Wes

I'm 60, so that's my perspective. To many of us, it seems like the people in the cubicles, doing what ever it is that they do, are taking over the country, to its detriment. We can't do anything anymore. The F35 is an excellent example of group think incompetence. Six Sigma, 5S, Quality this that and the other all seek to remove individual initiative from the process of making things and turn people into interchangable cogs. Now medicine is under attack from the cubicle people. I feel bad for you, and worse for me as I enter my golden years.

Come on Dr Wes - you school the press all the time. I am not saying you are wrong, just saying that it goes on all the time. Admittedly, with the focus on healthcare, physicians are probably getting more than their fair share at the moment but many, many professions have had their periods of high scrutiny. Certainly school teachers have faced similar public assualts, as have many other professions. Unfortunately the only way to counter it is to create a successful forum to tell your side of the story. You are doing it with your blog, but you could probably use more help from groups like the AHA, ACC, HRS, etc. Keep telling your story.

We have become a society governed by "mindless metrics", formulated by ignorant task masters who view human services from a cold, calculated business/systems perspective. Not limited to healthcare mind you, it underlies many maladies affecting our society. The teachers' cheating scandal in Atlanta probably has its roots in the Law of Unintended Consequences that arise from the dictates of individuals incapable of appreciating the indeterminacy of human behavior.

As an illustrative example, many hospital ED's use patient throughput as the defining metric. They brag about it in their insipid ads. The result? Someone with a hemoglobin of 6 ends up in a regular room without anyone bothering to perform a rectal exam in order to determine if the patient might be having a life threatening GI bleed. Efficiency first! I've seen it first hand. But as long as things breeze along, and administrators smile, who cares?

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.